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29-360 (8) Z C, -4- CTS f4 , 0 r 4 16 O rl\ CID -1t 9A..`rr�..s... ..w..,.—..,....�.. .... ti a'ay r 04/2712005 19:06 FAX 1 419 527 1222 ALL STAR wj003 ri Tii CO Ow � 'N �• a,s:.' -.i.� +'-7i iK.,:'"' '�'''��,h _ rr11 .►-' ,a(i I1 {i ` J Ln w V) JN Or- }. q, . A o `� `� K. A T� ti . e Crib ofarfTar�t #on � � �iaarach��rttr z DEPARTMENT OP SUILDrNa INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass, 01060 , WOR MR'S COMPENSATION INSURA2. CE A..p'FIDAVIT I, ED LOSACANO, 34NER OF ALL STAR INSULATION &_SIDING CO. , INC. (li cetlseeJ pe rmi rt.ee) with a principal place of businessiresldence at; 56 FRANKLIN STREET, EAST,AWTON, MA (phone#) 413-527-0044 (stz-cxt/ci ry/stalrJ�p) do hereby certify, under the pains and penalties of perjury, that (X) I am an employer providing the following worker's compensation coverage for my employees working on this)ob'. (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hued the contractors listed below wbo have the follow..og worker's compensation policies: (Name of Contractor) (Insurance Company/Poucy Numbcr) ('Expiration Date) (Name of Contractor) Onsurance Company/Policy Number) (Expiration Date) (Name of C0=M(z7tor) (lnsuran(--- Comparry/PoUcy Number) (Expiration Date) (Name of Contractor) (Insurance Com,,al ,ToUcy Numb,--r) (Expiration Date) (aaac3r a.dditioaaJ rbact if nocca.ary w wcludo inlotmsUOa pauan.ng l4 Ali ooauacton) ( ) I am a sole proprietor and have no one worLng for me. ( ) I am a home owner performing all the work myself. NOTE:plcaae be award thatµ4610 h�W C"'k'�c=l•�y m co en¢n,=cnincc corarr.:c�oo or repair work.oo t dwelling of not Mom t�L-.n Lbm4 mfu in w{bcb the boma wocr res:t— x x I--`Y ,r _:r� a '� c a�t�ccto—oa g=OC'&11y coo316croi"be empl oy'T-3 wy a ttx H 7ri«'a A (G- i(-`:'. c r',:a c�o•± fcr e ti ccusc of per=may cvrdcaoc tho lcgzl claws of an osployet uncle.the Worka't Coa�poaii:xro Nx ___-- i I undo s d thst a coFy of this mtemcm may be fora-nrded to tbo Dcpermiacsr of l'&urri el A.=6W&Offloo of Imurwco for the coven-Lge verification and ttu.t allure to s4c u coYrm;t vaSG sccion 25 A of?.1GL 152 can lead a tbo imposi2ioa of-M--J Pcrattica 00awcng of t fmc of up to S1.500.00 knSor of up to one year and civil peen".ia in the form of a Stop Work Order and a &m oC 5100.00 a day tplwq mc- For dgwunaaW use-1Y -� Permit Number -] ma pg Lot# S i gnahue of L iacnscrlP c rmi tzce SF fi OMTRUCT.104'SERVICES 1 Licensed Con,strilctlon Su erp vlsor: t }� � �^/ Not�Applicable q❑ NXTI111�L icens�}{older : AnAL �� l !l(/ )656 1 © "o /23 d� a License Number Address Expiration Date ++ 1 . � i 3 Signature;'; ` Telephone y r.,}!• r, ,,„ sa 3% Not Applicable l] �tr�cto rtk�t4li, �'`x.,�`>' �4f...:t a . }�'�,AJP�t�� '.0..91. /0/0.5 Registration Number it .. 65 ( 'L Address,:::i. J Expiration Date nA Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M•G.L, c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed ano submitted with this application, Failure to provide this affidav. will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes.,.,,,. O No..,,.. O Y "r• EM=- �„�y�z%er:Exemb on The current exemption for "homeowners" was extended to include Owner-occupied Dwellines of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time, du-mg and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for persons) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated, Homeowner Signature , %CTION'5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 17 Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ j Other [ ] 06'rief Description of Pro ose Wor R ern W6,A d I'5P06c Ca CX w5tftl16 bui I d A eu) &&CY-L 8' x ro, coTp—: naic(l s>1ita Alteration of existing bedroom Yes No Adding new bedroom Yes o r�x�5ti'N6 I, IKulL Attached Narrative 0 s Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 Ix3a ,; $o:ek*st1n&*housing, c0 a. Use of building : One Family Two Family Other r A b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft, of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No , I. Septic Tank City Sewer Private well Clty water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf, in'%all matters relative to work authorized by this building permit application. Signature of Owner Date I, Ed A l I i�T��1 �`Jl'�iTT l i ��c llC .) ICI i( J as Owner/Authorized Agent hereby declare that the statem nts and inforniation on the foregoing applicati n are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. aun �o, on n� Print Name Signature of Owner/Agent Date - r- • Section 4, ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size V P3 � • Frontage � Setbacks Front Rear I(�fJ•� Building Height d I alls t Ito . Bldg, Square Footage 51""►^r� % t !r Open Space Footage (Lot area minus bldg&paved _parking) 4 of Parking S aces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW ✓ YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # Z B, Does the site contain a brook, body of water or wetlands? NO DON'T KNOW ' YES IF YES, has a permit been or need to be obtained from the Conservation Commission?. Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: :City of Northampton - BPilding Department 212 Main Street Room 100 Northampton, MA 01060 -,phone,413 4,87.1240 Fax 413.5871272 APPLICATION TO CONST�UCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I II . 0 t1 ' 1111SITE:{NFORMATION Il r Property er This ti �y Ad dress: 35 map r���,._.1�YL._ 1 �v Zone ,Qw, �>Str.,iGt Elm St. District CB District__ SECTION 2 • PROPERTY OWNERSI IP/AUTHORIZED AGENT 2.1 Owner of Record: I Name(Print) Cur ent Mailing Address: Telephone , Signature l 2.2 Authorized Agent: ALL STAR INSU.ATION & SIDING CO., INC. 56 FWWKLIN STREET, EASTHPA'1PTON, MA 01027 Name(Print) Current Mailing Address: 413-527-W Signature Telephone Item (Estimated Cost (Dollars) to be Official Use Only om leted by ermit applicant 1, Building jl �f j .62) (a) Building Permit Fee 2. Electrical t (b) Estimated Total Cost of Construction from 6 3, Plumbing Building Permit Fee 4, Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number C� D This Section For Official Use Only Building Permit Number: Date Issued; Signature: ` Building Commissioner/Inspector of Buildings Date t � File#BP-2005-1042 i APPLICANT/CONTACT PERSON All Star Insulation&Siding Co Inc ADDRESS/PHONE 56 Franklin Street EASTHAMPTON (413)527-0044 PROPERTY LOCATION 235 A IREBROOK DR MAP 29 PARCEL 360 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: i PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REBUILD EXISTING 8 X 10 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or Licexlse 069281 3 sets of Plans/Plot Plan THE FOLLOWING ACTION AS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,MATION PRESENTE pproved Additional ermits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan i ZONING BOARD PE"IT REQUIRED UNDER: § Finding Special Permit Variance* Received&Re�orded at Registry of Deeds Proof Enclosed Other Permits Required:.; i Curb Cut from DPW Water Availability Sewer Availability I Septic Approval Board of Health Well Water Potability Board of Health Permit from Cod servation Commission Permit from CB Architecture Committee Permit from Elm Street Co 'ssion i /Z,9 /'C�(22f Signature of Building Official Date Note:Issuance of a Zoning p Irmit does not relieve a applicant's burden to comply with all zoning requirements and obtain all�equired permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 235 ACREBROOK DR BP-2005-1042 Gls#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-360 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Deck Addition BUILDING PERMIT Permit# BP-2005-1042 Project# IS-2005-0937 Est.Cost: $2861.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: All Star Insulation & Siding Co Inc 069281 Lot size(sq. ft.): 16030.08 Owner: MARROCCO MARLENE Zoning-:URA Applicant: All Star Insulation & Siding Co Inc AT: 235 ACREBROOK DR Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:512105 0:00:00 TO PERFORM THE FOLLOWING WORK.-REBUILD EXISTING 8 X 10 DECK i POST THIS CARD SO IT IS' ISIBLE FROM THE STREET Inspector of Plumbing Inspec r of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough# House# Foundation: Driveway Final: Final: Final: Rough Frame: i Gas: Fire D e artment Fireplace/Chimney: Rough: Oil• Insulation: it Final: Smok : Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND 9EGULATIONS. Certificate of Occupancy i Signature: FeeType: Date Paid: Amount: Building 5/2/05 0:00:00 $50.00 j212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo